Ayurveda and Geriatric Care

1

1. Demographic context of Geriatrics and limitations of conventionalmedicine

1.1. Demographic trends

The World population of the elderly is increasing and by the year 2050,adults older than 65 years will comprise 1/5th of the global population. InIndia 3.8% of the population are older than 65 years of age. Accordingto an estimate the likely number of elderly people in India by 2016 will bearound 113 million.

1.2. Global health scenario in geriatrics

The twenty-first century is witnessing a gradual decline in fertility, andwith increase in life expectancy, the society will need to grapple withissues of longevity. The cause of morbidity and mortality world over isshifting from communicable diseases a few decades ago to non-communicable diseases. The leading causes of mortality among agedpeople comprise respiratory problems, heart diseases, cancer and stroke.Significant causes of morbidity among this group is chronic inflammatoryand degenerative conditions such as Arthritis, Diabetes Osteoporosis,Alzheimer’s disease, Depression, Psychiatric disorders, Parkinson’s diseaseand age related urinary problems.

1.3. Limitations of conventional medicine in the management of noncommunicable diseases

The stupendous success of conventional medicine in the managementof communicable disease especially in the west was owing to theidentification of a single cause in the form of a parasite/causativeorganism for all communicable disease and a systematic plan of actionwas derived to counter the cause which then cured the disease.However, the biggest challenge with geriatric problem is that in most ofthe cases the condition cannot be attributed to a single cause or incertain conditions like neuro-psychiatric disorders (Senile dementia,Alzheimer’s depression), the structural cause is unknown. In such casesthe conventional medical therapy fails to come out with effectivemanagement plan and hence is severely compromised. Anotherchallenge with conventional medical therapy is that it does not have

AYURVEDA AND GERIATRIC CARE -A BROAD OUTLINE

2

AYURVEDA AND SIDDHA

health promoting agents. Ayurveda on the other hand has interventionsthose enhance physiological processes that influence metabolic andimmunological status (cyavanaprasha, triphala) and such interventionsare significant in the context of geriatric care.

2. Ayurvedic clinical experience on geriatrics

2.1. Ayurvedic understanding of geriatrics

Ayurveda has a focused branch of medicine called Rasayana(Rejuvenation) which exclusively deals with the problems related toaging and methods to counter the same. Geriatrics or Jara cikitsa orRasayana in Ayurveda is a method to control / slow down / arrest theaging process in the human being during the degenerative phase ofone’s life.

Rasayana is normally advised during this degenerative phase which startsfrom around 45 yrs in both male and female. A holistic system like Ayurvedaapproaches this condition through two-fold methods. One is a radicalapproach in which it recharges the whole metabolic process of the bodyby eliminating the toxins from the system by a three to four months rigorousand organized process known as Kutipraveshika Rasayana. However,this process is seldom practiced due to the extreme intricacy of thephysiological process involved and the need for utmost care to be takenby the physician and subject including the environment where thetreatment is done. Hence this Kutipraveshika remains as a textual marvelof Ayurveda than a practical process of contemporary relevance.

The second approach of Ayurveda, which is quite popular today, iscalled Vataatapika Rasayana – which can go along with the normalday to day life. This type of Rasayana is particularly important in thecurrent scenario as it has a relatively easy mode of administration withoutany restrictive pre-conditions.

Apart from this, Rasayana are also classified as:

A. Medhya Rasayana: Rasayana that act specifically as brain tonics,eg: Shankhapushpi, Mandukaparni, Yashtimadhu and Guduchi.

B. Vardhamana Rasayana: Rasayana given in a gradual step-updosage from a minimum to a maximum dose followed by a taperingback, eg: Vardhamana Pippali Rasayana.

C. Droni-Praveshika Rasayana: A very spectacular form of Rasayana,where in a person is made to consume stomach full of the juice of

3

8 rare herbs and made to lie down in a wooden casket for a periodof 6 months (unconscious). This again has no known history of beingperformed anywhere in the near past, although finds a mention inthe text as being one that will enable an old person to completelyregain his youth.

2.2. Core areas of strength in Ayurveda

Undoubtedly the strength of Ayurveda in the context of Geriatric care isRasayana therapy, which is unique because of its ability to promotelongevity and influence all aspects of health in a positive way. Describingthe effects of Rasayana, the classical texts of Ayurveda say that fromRasayana one attains longevity, improved harmony and intelligence,freedom from disorder, youthful vigor, excellence of luster, complexionand voice, optimum strength of physique and senses, command overlanguage, respectability and brilliance. Ayurveda considers the physicalstructure to be composed of 7 dhatus starting from Rasa (Rasadi Dhatus)and Rasayana is the tool to create premium dhatus (body tissues).

The main utility of Rasayana therapy is in functional and degenerativedisorders that have a chronic or long standing nature. In such cases, infact, Rasayana is the only solution from the point of view of effectivemanagement in any system of medicine. Rasayana becomes more fruitfuland effective if it is preceded with suitable panchakarma (purificatorytherapy). The reason we see mixed results in many cases where Rasayanais employed is because of the fact that either this purification is not doneor improperly done.

Panchakarma is a bio-cleansing regimen comprising of five mainprocedures that facilitates better bioavailability of the pharmacologicaltherapies, helps to bring about homeostatsis of body-humors, eliminatesdisease-causing complexes from the body and checks the recurrenceand progression of disease. The five fold measures comprehended inthis therapy are Vamana (Therapeutic Emesis), Virechana (TherapeuticPurgation), Astapana Vasti (Therapeutic Decoction Enema), AnuvasanaVasti (Therapeutic oil Enema), Nasya Karma (Nasal administration ofmedicaments). Panchakarma procedures are preceded by Snehana(Therapeutic Oleation) and Swedana (Sudation) applications to makethe body system conducive for elimination of bio-toxins and cleansingof channels. This is effective in managing autoimmune, neurological,psychiatric and musculo-skeletal diseases of chronic and metabolicorigin.

4

AYURVEDA AND SIDDHA

Single Rasayana drugs for some specific disease conditions

Diseases of Eye: Jyotishmati (Celastrus paniculata), Triphala (Three myrobalans),Satavari (Asparagus racemosus), Yastimadhu (Glycyrrhiza glabra) andAmalaki (Emblica officinalis).

Diseases of Heart: Salaparni (Desmodium gangaticum), Arjuna (Terminaliaarjuna), Guggulu (Commiphora mukul), Pushkaramula (Inula racemosa)

Skin diseases: Bhallataka (Semecarpus anacardium), Vidanga (Embelia ribes)and Bakuchi (Psoralia corylifolia).

Rasayana for overall Health: Guduchi (Tinospora cordifolia), Amalaki (Emblicaofficinalis), Aswagandha (Withania somnifera), Cow’s milk and Takra.

Asthma: Sirisha (Albezia lebbeck), Agastya (Sesbania grandiflora), Haridra(Curcuma longa), Haritaki (Terminalia chebula).

Arthritis: Rasona (Allium sativum), Guggulu (Commiphora mukul), Aswagandha(Withania somnifera) and Shunthi (Zinziber officinale).

Neuropathies: Rasona (Allium sativum), Guggulu (Commiphora mukul), Bala(Sida cordifolia), Aswagandha (Withania somnifera).

Diabetes: Silajitu (Black bitumen), Amalaki (Emblica officinalis), Haridra(Curcuma longa), Tejpatra (Cinnamomum tamala), Methika (Trigonellafoenum graecum).

Lipid disorders: Guggulu (Commiphora mukul), Haritaki (Terminalia chebula),Pushkaramoola (Inula racemosa), Vaca (Acorus calamus).

Hypertension: Rasona (Allium sativum), Sarpagandha (Rauwolfia serpentina),Aswagandha (Withania somnifera), Jatamansi (Nardostachys jatamansi).

Brain and Memory Disorders: Brahmi (Bacopa monnieri), Mandooka parni(Centella asiatica), Jyotishmati (Celastrus paniculata), Kapikachhu(Mecuna pruriens), Tagara (Valeriana wallichii).

Some Compound formulations that are available in the market with a multi-pronged action are being listed below:

• Chyawanprasha

• Brahmi Rasayana

• Aswagandha Lehyam

• Mahatriphala Ghrita,

• Triphala Curna

5

• Aswagandha Curna

• Narasimha Rasayana

• Agastya Rasayana

• Amalaki Rasayana

3. Challenges for contemporary application of Ayurvedic geriatrics

3.1. Contemporary application of Ayurvedic geriatrics

Ayurvedic treatment as such is very individualistic and one medicinefound to be useful in a condition in a particular person may not work atall in another. Hence, it is a challenge to come out with generalizedmanagement solutions for a condition that would suit all. It is difficult tobring out management plans for a particular disease condition andimplement the same in a large scale.

It is important that we respect both holism (of traditional medicine) aswell as reductionism (of modern bio-medicine) because both are waysof looking at nature and depending on the purpose both the views canbe extremely useful. Furthermore the whole and the part are certainlyrelated but it is not a one-to-one relationship. The understanding that it isnot one-to-one relationship and learning how to relate the wholeperspective (the systemic theories of Ayurveda & Yoga) with part(structural theories of western biomedicine) is the outlook that shouldunderline the implementation of trans-disciplinary research projects.Today, nobody in the academic field has all the answers of how tocombine and correlate part and whole perspectives in the context ofclinical research design, clinical practice, content of courses onAyurveda and Yoga, in the context of laboratory research inpharmacognosy and product development, and in assessment ofcommunity based local health practices. It is important to understandthat drug trials for evaluating efficacy of Ayurvedic interventions is areductionist approach and is an inappropriate design. Instead, clinicaltrials should evaluate the efficacy of a whole management packagewhich may consist of drugs, diet, Yoga, Panchakarma includingdifferential diagnosis to identify the specific nature of tridoshicimbalance.

3.2. Developing ambitious projects of trans-disciplinary clinical research onkey geriatric problems

The biggest challenge in the contemporary application of Ayurvedic

6

AYURVEDA AND SIDDHA

geriatrics would be to come up with protocols to document, diagnosein an integrative frame work and manage geriatric problems. This wouldrequire critical investment (the current strategies are subcritical) inestablishing advanced research, treatment and teaching centers thathave a state of the art facility to deal with geriatrics.

4. The policy issues

It is important for policy makers to firstly recognize the fact that geriatrichealth care has to be managed in a pluralistic way because no singlesystem of medicine has the capacity to address the health care needsof the growing size of the aged population. Policy therefore needs toclearly identify the key areas for support in Ayurvedic geriatrics and makeplans and proposals for critical investments in such areas. A range ofboth Govt. and Non-Govt. institutions with either promising or outstandingleadership need to be identified and encouraged to prepare ambitiousproposals commensurate with the magnitude of the social problem ofold-age care. Unless generous funding is invoked, it will be like trying toplough a huge field with a stick instead of modern tractors. It is essentialthat a multi-dimensional intervention be conceived that will involve a)trans-disciplinary research b) advanced treatment centers and c)specialized post graduate education. There is a very urgent need toestablish centers in the country that would engage in the kind of trans-disciplinary research that we are envisaging in order to take Ayurvedaglobally and also to bring the clinical services of Ayurveda into themainstream. This would require a generous funding for undertaking suchresearch and also establishing centers that would provide effectiveclinical services. There is also a need to support specialized trans-disciplinary PG researches in centres where PG in geriatrics is offered.

The areas for policy interventions are outlined below:

4.1. The need for generous funding for Ayurvedic Geriatric research andclinical services

4.2. Building treatment capacities in reputed Govt. and Non-Govt. institutesfor geriatrics

4.3. Support advanced clinical centers for Geriatric care in reputedinstitutions in the Govt. and Non-Govt. sectors

4.4. Support specialized trans-disciplinary PG education courses in geriatriccare

7

BACKGROUND

Aging is a process of physical, psychological and social change inmultidimensional aspects. Some dimensions of aging grow & develop withtime while others decline. The world population of the elderly is increasingsignificantly, and by the year 2050, adults older than 65 years will comprise1/5

th of the global population. In India 3.8% population are older than 65 yearsage. According to an estimate the likely number of elderly people in India by2016 will be around 113 millions.

The aged population in India is mostly in rural than the urban. The othersignificant feature in the aged population is that number of females is morethan males and are residing in pitiable situation in rural India.

The Indian traditional culture respects the aged, but the shift to the nuclearfamily pattern the aged individuals are neglected. The important issues in agedpopulation are many like social, economical etc. but more than these is health.The Ayurveda & Siddha traditional holistic health sciences are very muchpotential in prevention of diseases by promotion of health & management ofmetabolic syndromes occurring in old age.

Twentieth century has seen gradual decline in fertility, the growth rateof population but with increase in life expectancy. As a result society isgrappling with longevity issues. Though worldwide demographic revolutionis a social achievement, yet the consequences of longevity inter alia arelarger number and proportions of older people that influence financing ofhealth care.

The growing number and proportion of elderly persons is placing theincreasing demands on Public Health System and on medical and socialservices. Most of the older people are suffering from at least one chronicdisorder and they may be suffering from multiple of disorders. Their quality oflife as a result is suffering and also poses a burden on their family and caregivers.The leading causes of illness and death among aged peoples compriserespiratory problems, heart diseases, cancer and stroke. Chronic inflammatoryand degenerative conditions such as Arthritis, Diabetes, Osteoporosis,Alzheimer’s disease, Depression, Psychiatric disorders, Parkinson’s disease andUrinary incontinence diminish the quality of life.

RASAYANA - HEALTHY AGING

8

AYURVEDA AND SIDDHA

Although the risks of developing diseases rises with advancing age, butit is not an inevitable consequence of aging. Prevention and managementof health problems could help the elderly to improve quality of life and remainindependent for their daily activities to certain extent.

Ayurveda literatures record vivid information about the concept of agingprocess and loss or impairment of tissue system/ functions during variousdecades of life and their management. Ayurveda has broad spectrum ofpreventing measures for combating the aging process which is in practice inlarge number of people in our country.

National Policy for aged under the Ministry of Social Justice and Empowermentseeks health security of older people and it recognizes special health needsof the older persons to be met through strengthening and reorienting of publichealth services at Primary Health Care level and creation of health facilities.

Some of the well known centers of Ayurveda & Siddha viz CentralResearch Institute (Ayurveda) (CCRAS) ,Cheruthuruthy Kerala, NationalInstitute of Ayurveda, Jaipur, Rajasthan, Institute of Post Graduate Teaching& Research in Ayurveda (IPGT&RA), Gujarat Ayurveda University, Jamnagar,Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University,Govt. Ayurveda College, Thiruvananthapuram, Central Research InstituteSiddha (CCRAS), as well as National Institute of Siddha, Chennai are cateringsignificant health care services in the field of Geriatrics.

A few Societies and NGOs viz. Association of Gerontology, Geriatric Societyof India, Parkinson’s & Ageing Research Foundation, Helpage India, Age wellFoundation etc. are engaged in support activities related to Geriatric Care.

Geriatric clinics and M.D. course in Geriatric are functioning at BHU, Varanasi,AIIMS, New Delhi, MGIMS, Wardha and Maulana Azad Medical College, NewDelhi and so on.

POTENTIAL AND STRENGTH

Ayurveda attributes primary importance to preventive and promotivehealth care and the maintenance of positive health. The major preventiveapproaches for maintaining and improving the quality of life includeindividualized specific daily regimen (Dinacharya), seasonal regimen(Ritucharya), behavioral and ethical considerations (Sadvritta). Healthy lifestyleis emphasized as the determinant of longevity of life, which by and largedepends on the Prakriti (bio-identity i.e. body-mind constitution) of an

9

individual. Proper understanding of Prakriti leads the physician in making rightdiagnosis, prognosis and treatment plan and in guiding patients as well ashealthy individuals, what do’s and don’ts they need to follow for restorationand maintenance of health.

Rasayana therapy is a specialized branch of clinical medicine in Ayurvedaaimed at preventing the effects of aging and to improve intelligence, memory,complexion and sensory and motor functions. Numerous single and compoundRasayana medicines possessing diversified actions like immuno-enhancement,free-radical scavenging, adaptogenic or anti-stress and nutritive effects aredescribed in Ayurveda literature for their use in health promotion andmanagement of diseases with improvement in the quality of life. RasayanaTherapy can be advocated at out door level (Vatatapika Rasayana) andwith hospitalization also (Kutipraveshika Rasayana) depending upon the needof patients.

Panchakarma is a bio-cleansing regimen comprising of five main proceduresthat facilitates better bioavailability of the pharmacological therapies, helpsto bring about homeostasis of body-humors, eliminates disease-causingcomplexes from the body and checks the recurrence and progression ofdisease. The five fold measures comprehended in this therapy are Vamana(Therapeutic Emesis), Virechana (Therapeutic Purgation), Astapana Vasti(Therapeutic Decoction Enema), Anuvasana Vasti (Therapeutic oil Enema),Nasya Karma (Nasal administration of medicaments). Panchakarmaprocedures are preceded by Snehana (Therapeutic Oleation) and Swedana(Sudation) applications to make the body system conducive for eliminationof bio-toxins and cleansing of channels. This is effective in managingautoimmune, neurological, psychiatric and musculo-skeletal diseases ofchronic and metabolic origin.

Ayurveda and Siddha Literatures record numerous single and compoundplant based medicines (majority) and herbo-mineral, herbo-metalic (a few)formulations for general good health and disease specific indications relatingto Geriatrics.

Single Rasayana drugs for some specific Disease conditions

Diseases of Eye: Jyotishmati (Celastrus paniculata), Triphala (Three myrobalans),Satavari (Asparagus racemosus), Yastimadhu (Glycyrrhiza glabra) and Amalaki(Emblica officinalis).

10

AYURVEDA AND SIDDHA

Diseases of Heart: Salaparni (Desmodium gangaticum), Arjuna (Terminaliaarjuna), Guggulu (Commiphora mukul), Pushkaramula (Inula racemosa).

Skin diseases: Bhallataka (Semecarpus anacardium), Vidanga (Embelia ribes)and Bakuchi (Psoralia corylifolia)

Rasayana for overall Health: Guduchi (Tinospora cordifolia), Amalak (Emblicaofficinalis), Aswagandha (Withania somnifera), Cow’s milk and Takra.

Asthma: Sirisha (Albezia lebbeck), Agastya (Sesbania grandiflora), Haridra(Curcuma longa), Haritaki (Terminelia chebula).

Arthritis: Rasona (Allium sativum), Sallaki (Boswellia serrata), Guggulu(Commiphora mukul), Aswagandha (Withania somnifera) and Sunthi (Zinziberofficinale).

Neuropathies: Rasona (Allium sativum), Guggulu (Commiphora mukul), Bala(Sida cordifolia), Aswagandha (Withania somnifera).

Diabetes: Silajitu (Black bitumen), Amalaki (Emblica officinalis), Haridra(Curcuma longa), Tejpatra (Cinnamomum tamala), Methika (Trigonellafoenum graecum).

Lipid disorders: Guggulu (Commiphora mukul), Haritaki (Terminalia chebula),Pushkaramoola (Inula racemosa), Vacha (Acorus calamus).

Hypertension: Rasona (Allium sativum), Sarpagandha (Rauwolfia serpentina),Aswagandha (Withania somnifera), Jatamansi (Nardostachys jatamansi).

Brain and Memory Disorders:- Brahmi (Becopa monnieri), Mandooka parani(Centela asiatica), Jyotishmati (Celastrus paniculata), Kapikachhu (Mecunapruriens), Tagara (Valeriana wallichii).

SOME COMPOUND FORMULATIONS

• Cyawanprasa

• Brahmi Rasayana

• Aswagandha Lehyam

• Mahatriphala Ghrita,

• Karisalai Legiyam

• Triphala Curna

11

• Aswagandha Curna

• Pranada Gutika

• Narasimha Rasayana

• Agastya Rasayana

• Amalaki Rasayana

• Ayajambeera Karpam

• Bavana Kadukkai

• Ayabringaraja Karpam

AT A GLANCE

• Multiple actions of Rasayana therapy includes immuno-modulation,antioxidant action (prevents bio-oxidation thereby checking agerelated disorders, auto immune disorders, degenerative disorders),adaptogenic (anti-stress) affects and so on.

• Time-tested holistic and comprehensive remedies for on Nature’s Lawscan address the gaps in health care of old people.

• Lifestyle modulation (Swathavritta and Sadvritta) remains integral tothe treatment.

• Most cost – effective; affordable by all sections of People

• Well tolerated; no Adverse Drug Reactions

• AYUSH systems have specialized therapeutic procedures forrejuvenation, health promotion and prevention & management ofdegenerative health problems.

• Panchakarma & Yoga are proven to be efficacious in neuro-muscular,musculo-skeletal, psychosomatic, metabolic and many chronic healthproblems of elderly people.

EVIDENCE BASED RESEARCH

1. Brahmi (Bacopa monnieri) in the management of Senile Dementia.

Brahmi Vs Placebo: Administration of 1gm. of powdered extract of Brahmitwice a day for 5 years has shown significant reduction in the progressionof memory loss in persons suffering from senile dementia.

12

AYURVEDA AND SIDDHA

Reference: Role of the Ayurvedic Drug Brahmi (Bacopa monnieri) inthe management of Senile Dementia. Pharmacopsychologia(1990),3,47-52.

2. Butea monosperma root distillate in the management of age relatedimmature Cataract

The root distillate drops of Butea monosperma developed as per I.PStandards has shown significant improvement in visual acuity and qualityof vision (disturbance in vision viz. haziness, diplopia etc.) in the subjectsof age related immature cataract (n=52).

Reference: Srikanth N. et al., Butea Monosperma Root distillate eyedrops (Palasa Moola Arka) in age related immature cataract: A clinicalobservation, Journal of Research in Ayurveda and Siddha, Vol.XXVII.No.1-2, (2006) pp 12-23.

3. Aswagandha (Withania somnifera) on the process of aging

Aswagandha Vs Placebo: 3 gm. of root powder of Aswagandha(Withania somnifera) was administered in the dosage of two tablets threetimes daily with milk for one year showed statistically significant increasein Haemoglobin, RBC count, hair melanin & seated stature and decreasein serum cholesterol and ESR.

Reference: Kuppurajan etal, Effect of Aswagandha (Withania somnifera)on the process of ageing in Human volunteers . Journal of Research inAyurveda and Siddha.

4. Guggulu (Commiphora wightii) in Hyperlipidaemia

Guggulu (Commiphora wightii) Vs Placebo: Cardinal clinicalmanifestations of disease like precordial pain and dyspnoea wererelieved in in most of the cases in a clinical study tried with Guggulu inthe dose of 8 gm/day. Substantial fall in lipid fractions like cholesterol27%, triglycerides 36%, phospholipids 20% and free fatty acids 37%indicated the possibility of regression of atherosclerosis. The reversal ofECG changes substantiated the anti-ischaemic effect of the drug in thetreatment of ischemic heart diseases.

Reference: Clinical and Experimental trial of Guggulu (Medoroga). 1989Central Council for Research in Ayurveda and Siddha, Janakpuri,New Delhi.

13

5. Sallaki (Boswelia serrata) in Rheumatoid arthritis

Sallaki Vs Diclofenac sodium: 600 mg of Sallaki 3 times in a day and 50mg. of Diclofenac Sodium 3 times in a day was given in treated andcontrol groups respectively for 4 weeks. Efficacy of Sallaki was found tobe comparable to that of Diclofenac Sodium in the patients of RA, whodemonstrated predisposition for gastric intolerance with anti-inflammatory medication.

Reference: Bichile, LS et al., Double blind randomized controlled trialof Sallaki Vs Diclofenac in treatment of Rheumatoid arthritis, SelectResearch Papers on Evidence Based drugs in Ayurveda, Dept of ISM&H,Ministry of Health, Government of India, New Delhi-2000.

6. Management of Hemiplegia by Panchakarma therapy

Panchakarma Vs Palliative therapy: In a comparative study on 744hemiplegics revealed that 552 subjects who received Panchakarmatherapy showed significant recovery from illness, besides improvementin motor functions and quality of life in comparison to subjects whoreceived shamana therapy (Palliative therapy) alone.

Reference: Management of Hemiplegia by Panchakarma therapy,Central Council for Research in Ayurveda and Siddha, Janakpuri, NewDelhi-1990.

7. Multi-facetted protective role of Cyawanprasa

Cyawanprasa showed significant Immunomodulatory activity(Decrease in Ig G, C3 and C4 levels in patients of recurrent cough andcold), Cytoprotective action (Cancer patients receiving radiationtherapy showed a protective role against radiation induced tissuedamage)and Genoprotective action (significant reduction in MitoticIndex (MI) and Chromosomal aberrations (CA)).

Reference: NB Brindavanam, N.Bhattacharya, C.K.Katiyar and DBANarayana – Multi-facetted protective Role of Rasayana Therapy: Areview of investigations on Cyawanprasa–Ayurvedic Conference onRasayana 2002, Rashtriya Ayurveda Vidyapeeth

8. Anti-anxiety effect of an Ayurvedic compound drug

A double blind sequential cross over clinical trial with an Ayurvediccompound containing Mandukaparni (Centella asiatica),Yastimadhu

14

AYURVEDA AND SIDDHA

(Glycyrrhiza glabra) and Jatamansi (Nordostachys jatamansi) as trial drug,diazepam as control and placebo carried out on 12 patients of anxietyneurosis. It was found that Ayurvedic compound formulation is moreeffective in enhancing the perceptual discrimination and psychomotorperformance over placebo and control drug.

Reference: K.Kuppurajan et al - Anti-anxiety effect of an Ayurvediccompound drug – A cross over trial, Journal of Reserch in Ayurveda &Siddha Vol. XIII No. 3-4, PP 107-116.

9. Guduchi (Tinospora cordifolia) as immunomodulatory agent

Clinical studies of Guduchi (Tinospora cordifolia) have shown significantefficacy in the cases of obstructive jaundice.

Dahanukar et al., Immunotherapy with Tinospora cordifolia: A new leadin the management of obstructive jaundice by Tinospora cordifolia,Indian J Gastroenterol, 12 (1993) 5.

READING MATERIAL

1. Clinical & Experimental Studies on Rasayana Drugs & PanchakarmaTherapy, CCRAS, New Delhi, 1993.

2. Management of Hemiplegia by Panchakarma therapy, Central Councilfor Research in Ayurveda and Siddha, Janakpuri, New Delhi-1990.

15

BACKGROUND

Neurological disorders need greater attention as the age advances.Many neurological disorders (gait disorders), neurodegenerative disorders(Dementia) and neuromuscular disorders (Paralysis) affect the geriatricpopulation. Atrophy, peripheral sensory neuronal loss are also seen in old age.Marked vascular changes occur with aging. At age 80, brain blood flowdecreases by 20-28% and this parallels a decline in a cerebral metabolic rate.In addition, increase in cerebrovascular resistance with cerebralarteriosclerosis, vessel fibrosis and endothelial involution is seen with aging.Decrease in nerve conduction velocity, muscular functions are also seen inelderly individuals due to aging.

The functional impairments such as with devastating stroke arethreatening to an individual’s independence. Stroke is a disease of middleaged and elderly individuals. In U.S.A annual stroke cases are 7, 50,000 andthere is occurrence of one stroke in every 53 seconds and one stroke deathin every 3.3 minutes. In India exact data is not known, 30% people die in firstfew days of acute attack and among survivals 25% are suffering withdisabilities.

Atherosclerosis and uncontrolled HTN are the common causes ofCerebrovascular diseases and the associated risk factors like diabetes, heartdisease, hypercholesterolemia, smoking and excessive alcohol intake alsoplay an importance role in the pathogenesis of cerebrovascular diseases.

The effect of stroke on the individual can be devastating. The suddenloss of neurological function is unanticipated. Most young and all olderpatients experience drastic lifestyle changes may never return to employmentand may become dependent for even the simplest activity of daily living.Depression is common (up to 5%) following a stroke and interferes withrehabilitation, Insomnia, diminished appetite, poor attention and concentrationand a withdrawn feeling are frequently associated with stroke.

Pakshaghata (Hemiplegia) is mainly caused by vitiation of Vata causingdryness of sira and snayu and loss of function of one half of body.

Ayurveda provides both preventive, curative and rehabilitative

NEUROLOGICAL DISORDERS(Nadisansthanagata Roga)

16

AYURVEDA AND SIDDHA

measures for the management of stroke. Prevention is the best cure.Identification of risk factors and their treatment can prevent the occurrenceof stroke. Ayurveda offers various antihypertensive drugs, anticholesterolemic,antistress drugs, practicing of yoga and meditation, lifestyles and dietaryregime for the prevention of disease. For curative purpose or to rehabilitatethe patients and to treat disability after stroke Ayurveda has Panchakarmatreatment and Massage therapy. Various nervine tonics and bulk promotingdrugs are available for providing strength.


Preventive aspects - Ayurveda offers various herbal formulations to treat therisk factors for stroke. Life style regime as advocated in Ayurvedic literaturecan help in attaining mental peace. Yoga and meditation are both curativeand preventive measures.

1. Antihypertensive drugs – Arjuna, Pushkarmoola, Prabhakaravati,Hridyarnava Rasa, Arjunarista, Arjunakshirapaka, Sarpagandhadi Vati

2. Antihypercholesterolemic drugs – Arogyavardhini vati, Navakagugglu,Kaisor guggulu, Triphala Curna, Trikatu Curna.

3. Drugs for the management of stress and depression – Aswagandha Curna,Brahmi vati, Medhya rasayana, Saraswata Curna etc.

Panchakarma

• Mainly ‘Vasti’ therapy, Niruha Vasti with Dasamula Kwatha andAnuvasana Vasti with Mahanarayana taila or Bala taila provide strengthto neuromuscular system.

• Massage (Abhyanga) with strengthening oils to provide nutrition tomuscles and to prevent atrophy of muscles.

• Shashtikashali pindasweda.

Nervine tonics in Ayurveda

Dasamula Kwatha

Shilajatu

Aswagandha Curna

Saraswata Curna

Brahmi Ghrita

17

Oils for massage

• Mahanarayan Taila

• Bala Taila

• Prasarini Taila

• Mahamasha Taila

• Nirgundi Taila

• Panchaguna Taila


1. An Ayurvedic combination therapy in Hemiplegia

In a clinical trial, a combination of Ekangaveera rasa 250 mg twice daily,Masha taila for massage and Shastikashali pinda sweda for 45 days weregiven to the patients of Hemiplegia which showed good response insubjective and objective parameters as power and tone of the musclesin 42% cases.

Reference: L.K.sharma et al., A clinical study on pakshaghata(Hemiplegia) with a combination of Ekangaveera rasa, Masha taila andShashtikashali panda sweda, Journal of Reserch in Ayurveda & SiddhaVol. XXV No. 1-2 pp 53-66.

2. Hingutriguna taila-role in Hemiplegia

In a clinical trial on 35 patients of Pakshaghata, Hingutriguna taila 5mlorally 2-3 times a day with Abhyanga and Pindasweda twice a day isfound to be effective within 2 weeks and definite relief has beenobserved after 4-6 weeks of treatment.

Reference: Prem Kishore and M.M.Padhi, Role of Hingutrigunataila inthe treatment of Pakshaghata (Hemiplegia). Journal of Reserch inAyurveda & Siddha Vol. IX No. 1-2 pp 18-28.

3. Panchakarma treatment in Pakshvadha

In a controlled clinical study, 56 patients of hemiplegia were treatedwith Panchakarma treatment (snehana, sweda, mriduvireka and vasti)with taila and kasaya of Mashadi Yoga (Masha, Atmagupta, Eranda andBala) and in control group colored taila and Kasaya (of Manjistha) for

18

AYURVEDA AND SIDDHA

panchakarma treatment had been used. The trial has shown that thetreatment sneha, sveda, mriduvireka and vasti are effective but Mashadicompound has only slight effect on this disease.

Reference: S.Madhavan Pillai et al., Effect of Panchakarma treatmentwith Mashadi Yoga on Pakshavadha , Journal of Reserch in Ayurveda &Siddha Vol.I No.2 (1930) pp 301-328.

4. Sodhana therapy vs Samana therapy in Khanja and Pangu

In a control clinical trial Prabhanjanavimardanam taila for internal andexternal use as samana therapy, for external application only as placeboand for virecana and vastikarma as sodhana therapy were randomlygiven to patients of Khanja (Monoplegia) and Pangu (Paraplegia). Resultswere highly encouraging and statistically significant with samana andsodhana therapy and not significant with placebo. Further results insodhana group was found better in comparison to samana group

Reference: P. Ramachandran Nair et.al., Clinical evaluation ofPrabhanjanavimardanam taila and Sodhana therapy in themanagement of Khanja (Monoplegia) and Pangu (Paraplegia), Journalof Reserch in Ayurveda & Siddha Vol. XIII No.1-2 pp 14-26.

READING MATERIAL:

1. CCRAS Research an over view, CCRAS, New Delhi, 2002

2. Clinical & Experimental Studies on Rasayana Drugs & PanchakarmaTherapy, CCRAS, New Delhi, 1993

19

BACKGROUND

Musculoskeletal Disorders predominate in the older adults and are majorcause for chronic disability and health care utilization in the geriatric agegroup. Disorders of Musculoskeletal system impair mobility, interfering withactivities of daily living and function. These disorders are chronic in nature,not life threatening but affect the quality of life.

Due to ageing process, there is a decrease in hydration of cartilagesecondary to changes in proteoglycan structure, affecting water binding.There is an increase in crystallization and calcification, decrease in cellularityand probable decrease in the response to growth factor stimulation. All thesechange in the tissue results into less able to handle the mechanical stress.Fragility fractures have doubled in the last decade. 40% of all women over50yrs. will suffer an osteoporotic fracture. The number of the hip fractureswill rise from about 1.7 million in 1990 to 6.3 million by 2050.

Common musculoskeletal disorders found in Geriatric group areOsteoarthritis (Sandhivata), Rheumatoid arthritis (Amavata), Spondylosis andOsteoporosis (Asthi soushirya), Back pain (Katisoola), etc. It is found that nearly20% to 30% of Rheumatoid arthritis patients present after age 60. It is a chronicmulti-system disease, which affects mainly the joints. Remissions are less likelyin the elderly with established disease, resulting in much discomfort and disabilityin patients with Rheumatoid arthritis. Osteoporosis is common in older adultsand is associated with enormous morbidity from complications.

Ayurvedic classics have comprehensive description on the pathophysiologyand management of Musculoskeletal disorders like Sandhigata vata, Amavata,Vataroga, etc. Ayurveda also considers these musculoskeletal disorders tobe prevalent in elderly persons as the domination of Vata is predominant inold age and it is mentioned that Vata rogas generally occurs in elderly persons.

Different procedures like Snehana (oleation), Swedana (sudation), Vasti(medicated enema), Kativasti, Januvasti and a number of single andcompound formulations are practised in Ayurveda for the management ofthese disorders.

MUSCULOSKELETAL DISORDERS(Mamsa-Asthi-Sandhigata Roga)

20

AYURVEDA AND SIDDHA

In addition, preventive measures like Rasayana (Rejuvenation), Panchakarma(Bio-cleansing) therapy, dietary regimen and lifestyle practices are also equallypracticed for these disorders.


Preventive aspects: Specific do’s and don’ts for the prevention ofmusculoskeletal disorders are advisable. Use of Rasayana drugs andPanchakarma procedure can prevent the physiological changes in bonesand joints occurring due to aging.

Special Oleation (Snehana) and Sudation procedures (Swedana) likeKativasti, Januvasti, Grivavasti, Valuka swedana, Nadi swedana andPatrapinda pottali swedana are very effective in the management of thesedisorders.

Some single herbal drugs in musculoskeletal disorders

In single drugs following are giving promising results in the musculoskeletaldisorders.

1. Bala (Sida cordifolia)

2. Guggulu (Commiphora mukul)

3. Rasna (Pluchea lanceolata)

4. Eranda (Ricinus communis)

5. Bhallataka (Semecarpus anacardium)

6. Laksha (Laccifer lacca)

7. Kupilu (Strychnos nux-vomica)

8. Sunthi (Zinziber officinalis)

9. Aswagandha (Withania somnifera)

10. Nirgundi (Vitex negundo)

11. Guduchi (Tinospora cordifolia)

Some compound formulations in musculoskeletal disorders

1. Vaiswanara Curna

2. Aswagandha Curna

21

3. Rasna Panchaka Kwatha

4. Maharasnadi Kwatha

5. Dashmoola Kwatha

6. Rasna saptaka Kwatha

7. Yogaraj Guggulu

8. Mahayoga Raja Guggulu

9. Sinhnada Guggulu

10. Sunthi Guggulu

11. Saptavinsati Guggulu

12. Panchatikta Guggulu Ghrita

Some medicated oils for massage

• Narayana Taila

• Mahanarayana Taila

• Nirgundi Taila

• Panchaguna Taila

• Mahamasha Taila

• Pinda Taila

• Kshirabala Taila

• Dhanwantari Taila


1. Shunthi & Guggulu in Rheumatoid arthritis

A combination of equal parts of powder of Shunthi (Zingiber officinale)and Guggulu (Commiphora mukul) resin at a dose of 2 gm thrice dailywith Valuka Sweda (dry fomentation) was studied on 497 patients andvery good effect was found in 67% of patients after a course of 6 weekstreatment.

Reference: CCRAS Research An Overview, 2002.

22

AYURVEDA AND SIDDHA

2. Ayurvedic combination in Rheumatoid arthritis

A combination of Mahayogaraja Guggulu (1 gm), Vaiswanara Curna (3gm) twice daily and Simhanada guggulu (1/2 gm) at bedtime has beengiven in 518 patients and was found that, about 60% of the patients haveshown improvement.


3. Ayurvedic combination in Rheumatoid arthritis

A combination of Aswagandha curna 3gm thrice daily, Eranda taila 15ml at bedtime have been administered along with dry fomentation for atotal duration of 6 weeks. It was observed that, 57% of the patients haveshown improvement with the above therapy.


4. Sunthi Guggulu and Godanti in Amavata (Rheumatoid arthritis)

In a Clinical study of Sunthi Guggulu and Godanti on 80 cases ofRheumatoid arthritis encouraging results are found.

Reference: M. Mruthyumjaya Rao et al., Clinical evaluation of efficacyof Sunthi, Guggulu and Godomti in the management of Amavata (RA).Journal of Reserch in Ayurveda & Siddha, Vol. XXVI. No. 3-4 (2005)Page: 80-94

5. Shallaki as an Add-on therapy along with NSAID in the management ofOsteoarthritis

In a clinical trail on patients of Osteoarthritis, Sallaki 400 mg thrice dailyfor a period of 4 weeks in addition to routinely prescribed NSAID weregiven. After a period of 4 weeks NSAID was withdrawn and only Sallakiadministered for an additional two weeks period. It was observed thatthe improvement in signs and symptoms was sustained until the sixth weeki.e. even after discontinuation of the NSAID therapy. Supplementationof the NSAID with Sallaki resulted in a significant reduction in pain,tenderness, swelling, morning stiffness and functional impairment of theaffected joints.

Reference: Rajadhyaksha A.Chauhan et.al. Open study to evaluate theefficacy of Sallaki as an Add-on therapy along with NSAID in themanagement of patients with Osteoarthritis, Selected papers onevidence based Ayurvedic drugs, CCRAS, 2001.

23

6. Vaitaranavasti, Patrapinda Sweda in Inter vertebral disc prolapse

Vaitarana Vasti (medicated enema) with prior Patrapinda Sweda(medicated fomentation) has been tried on 72 patients suffering frominter-vertebral disc prolapse with sciatica and other related problems.The overall treatment was found encouraging and good relief is seen in47% of cases and fair relief in 26% of cases.

Reference: P.K.S. Nair et. al. Journal of Reserch in Ayurveda & Siddha,Vol. XXII, 3-4 (2001) Page: 120-130.

7. Guggulu (Commiphora mukul) in Osteoarthritis

In a clinical study on 30 male and female patients each Commiphoramukul in capsule form (500 mg concentrated extract) thrice daily alongwith food showed significant improvement in both the subjective andobjective parameters used for assessment purpose and no side effectwas noticed during the trial.

Reference : Singh B.B.et.al. The effectiveness of Commiphora mukul forOsteoarthritis of the knee- an outcome study, Altern Ther Health Med.2003 May-June 9 (3):74-9

READING MATERIAL:

CCRAS Research an over view, CCRAS, NewDelhi 2002.

24

AYURVEDA AND SIDDHA

BACKGROUND

Cardiovascular diseases are the most frequent causes of death in thegeriatric age group. Significant physiological changes in the heart and bloodvessels occur due to aging (Cardiac mass increases, vascular fibrosis andcalcification occurs). Increased collagen deposition, calcification, smoothmuscle cell proliferation and elastin breakdown lead to vascular thicknessand stiffening. There is also diminished capacity of heart to work. The incidenceof congestive heart failure, coronary artery disease, cardiac arrhythmias,valvular abnormalities and hypertension increases with age. Heart failureremains the leading cause of death in geriatric age. The causes of heart failurein the elderly are many. CHD remains the predominant cause. Prevalence ofcoronary heart disease (CHD) increases in older subjects, 80% of totalmyocardial infarctions (MI) occur in those more than 65 yrs. Angina pectoris iscommon presentation.

Hypertension is also one of the risk factor and there is a steady rise inaverage systolic and diastolic blood pressure with advancing age upto 70years age.

Treatment of cardiovascular disorders in elderly is difficult and need prolongedtreatment and there is a need for the safer drugs to use them for longer period.

Ayurveda offers satisfactory management strategies for cardiovasculardisorders through preventive and curative approaches. It provides clinicallyeffective and safe single and compound formulations to control the risk factorslike obesity, hyperlipidaemia, hypertension, and diabetes. In addition, thesedrugs are also helpful as an adjuvant and supportive therapy along with theconventional treatment. The adjuvant effect of Ayurvedic drugs has beenestablished through various studies.


Preventive potentials

Concept of well-balanced dietary regimen (fresh foods, seasonal fruits,salt restriction, etc.) and advocating exercise, Pranayam, yoga, sufficientsleep, avoiding anxiety, worry and emotional upset, regularly attendnatural urges, mantra chanting, positive attitude etc. in regard to heartdiseases is elaborately available in the Ayurveda literature.

CARDIOVASCULAR DISORDERS(Hridroga)

25

Curative aspectsDifferent effective and proven single and compound formulations tocontrol the risk factors like obesity, hyperlipidaemia, hypertension,diabetes are available in the Ayurveda classics. Some drugs (e.g.Terminalia arjuna) even reduce the hypertrophy of the cardiac muscle.

Some single and compound drugsChurna (Powders): (i) Arjuna Curna (Terminalia arjuna), (ii) Pushkaramula Curna(Inula recemosa), (iii) Trivritadi Curna, (iv) Haritakyadi Curna.

Vati (Tablets) and Guggulu: (i) Prabhakara Vati, (ii) Nagarjunabhraka ras,(iii) Hridayarnava Rasa, (iv)Navaka Guggulu, (v) Puskara Guggulu.

Asava & Arishta (Fermented liquids): (i) Arjunarishta, (ii) Punarnavasav,(iii) Dasamularishta, (iv) Chitrakadyarishta.

Ksheera paka (Processed milk with herbs): Lasuna Kshirapaka, Arjunakshirapaka.

EVIDENCE BASED RESEARCH1. Pushkara guggulu as an Antianginal and Hypolipidaemic drug

In a clinical trial on 150 patients of Coronary Heart Disease,Pushkarguggulu 6-8 g per day showed highly significant reduction incholesterol, triglycerides and total lipids. Significant improvement in thesymptoms and in ECG changes was observed with remarkable reductionin body weight.

Reference: Tripathi S. N. et al., Pushkaraguggulu an antianginal andHypolipidaemic agent in Coronary Heart Disease, Journal of Reserchin Ayurveda & Siddha, Vol. XII No. 1-2, pp 1-18

2. Lekhana Vasti (medicated enema) in Ischemic Heart DiseaseA clinical trial on 35 cases of essential HTN (mild-moderate) and IHD,Lekhana Vasti with Vaca (Acorus calamus) revealed significant reductionin mean systolic blood pressure, body weight and lipid profile.

Reference: P.K.Gupta et al., A study on the effect of Lekhana Vasti incases of Essential Hypertension and Ischemic Heart Disease, Journalof Reserch in Ayurveda & Siddha, Vol. XVI. No. 3-4 (1995) PP. 93-101

3. Terminalia Arjuna as an adjuvant in Hypertensives with LVHIn a controlled clinical study, with Arjuna Kwatha (25ml twice daily) alongwith atenolol (50mg daily) in treatment group and atenolol (50mg daily)alone as control was studied on hypertensive LVH patients. Significant

26

AYURVEDA AND SIDDHA

decrease in LV mass which was seen after 3 months and maintainedeven for a period of 6 months in treatment group. Whereas in controlgroup, regression in LV mass was insignificant.

Reference: B.Chandrashekhar Rao et al., Effect of Terminalia Arjuna W& A on regression of LVH in Hypertensives – A clinical study, Journal ofReserch in Ayurveda & Siddha, Vol. XXII No. 3-4 (2001) PP 216-227).

4. Arjunavacadi yoga in Hypertension (HTN)Arjunavacadi yoga a combination of Arjuna (Terminalia arjuna), Brahmi(Centella asiatica), Vaca (Acorus calamus) and Jatamansi(Nordostachys jatamansi) in the form of Ghana (aqueous extract) at thedose of 250-500mg thrice daily was given on 182 patients of VyanbalaVaishamya (HTN) for 3 months. A considerable fall in Blood pressure andimprovement in symptoms was observed in this study.

Reference: Bharti et.al Evaluation of efficacy of Arjuna Vacadi Yoga inVyanabala vaisamya (Hypertension) – A clinical study Journal ofReserch in Ayurveda & Siddha, Vol. XXVII No. 1-2 (2006) PP 57-66.

5. Guggulu (Commiphora wightii) in HyperlipidaemiaGuggulu 8gm daily Vs placebo: In a study with Guggulu 8gm/day,cardinal clinical manifestations of disease like precardial pain anddyspnoea were relieved in most of the cases; substantial fall in lipidfractions like cholesterol 27%, triglycerides 36%, phospholipids 20% andfree fatty acids 37% indicated the possibility of regression ofatherosclerosis. The reversal of ECG changes substantiated the anti-ischemic effect of the drug in treatment of ischemic heart disease.

Reference: Clinical and experimental trial of Guggulu (Medoroga), 1989,CCRAS

6. Guggulu (Commiphora wightii) as Hyper-cholesterolemic agentThe clinical studies with crude gum guggulu (Commiphora wightii)showed reduction in serum cholesterol levels in patients with obesityand hypercholesterolemia.

Reference: Satyavati G.V. Effect of an indigenous drug on disorders oflipid metabolism w.r.t. to atherosclerosis & obesity, M.D. Thesis BHU,1966,

READING MATERIAL:Clinical and experimental trial of Guggulu (Medoroga), CCRAS,New Delhi, 1989,

27

BACKGROUND

Respiratory disorders are among the most common cause of morbidityand mortality in elderly. Pulmonary function progressively decline after 25 yearsof age. The major changes with aging in lungs include decreased elastic recoil,stiffening of the chest wall and deteriorating respiratory muscle strength. Totallung capacity decreases with age, residual volume increases, due to smallairway closure during exhalation resulting in air trapping. Common respiratorydisorders like COPD (chronic bronchitis and emphysema), Asthma, Pneumoniaand Lung cancer are more likely to develop as the age advances.

Chronic Obstructive Pulmonary Disease (COPD) is defined as a diseasestate characterized by the presence of airflow obstruction due to chronicbronchitis or emphysema. COPD is the fourth leading cause of death in USAand a growing health problem. The prevalence of chronic bronchitis in ruralIndia may be high as 30% in the over 40 years age group where as in urbanIndia the incidence around 10%.

Asthma is a chronic inflammatory disorder of the airways. The prevalencerate of asthma in elderly people indicate that it varies from 6.5 to 10%approximately. Asthma manifests itself differently in children, adults and elderlypeople. In older people, it is not early to differentiate whether it is certainly acase of asthma as cough & breathlessness in this age group is a symptom ofother disease also because of poor respiratory function.

Treatment of COPD and asthma in older people needs much moreattention and care. Corticosteroids can cause softening of bone results in tofracture of fragile bone. Incidence of acquiring Tuberculosis also increases inpatients on therapy with of corticosteroids. Injection of adrenaline in statusasthmaticus endangers the heart and blood vessels of those who havehypertension and Ischemic Heart Disease.

Elderly people are more likely to get pneumonia. Elderly people tend tohave diminished cough and gag reflexes and weaker immune system. Inelderly people pneumonia can be fatal. It is the common cause ofhospitalization and prolonged hospital stay in the elderly.

RESPIRATORY DISORDERS(Swasansansthanagata Roga)

28

AYURVEDA AND SIDDHA

Thus the conventional therapy for respiratory disorders in the elderly hasmany side effects & limitations. In this juncture, there is need to search forherbal medicines in this field. Ayurveda has immense knowledge regardingdisorders of Pranavaha srotus (Respiratory system) like Kasa (Cough), Swasa(Dyspnoea), Kshaya (T.B.) and Kshata ksheena (Pleurisy) etc. the main dosainvolved in respiratory disorder are Kapha and Vata which causes constrictionof channels of respiration and obstruction in the respiration process at microand macro level. This leads to Pranavaha Srotas Dushti. Thus the principle oftreatment for pranavaha srotus is to bring normalcy in these dosas by Samana(palliative) medical treatment as well as Sodhana (bio-cleansing) Procedures.Ayurveda also offers dietary and lifestyle regimes for prevention of respiratorydisorders. Nidana Parivarjana (Avoidance of causative factor) is the principleof treatment for all diseases in Ayurveda. Satwavajaya (Psycho therapy) likelistening music, meditation helps in quality of mental and physical health.

Rasayana therapy (use of rejuvenative drugs acting on lungs), Yoga andPranayama are advocated classical methods for the prevention and cure ofrespiratory disorders.


1. Panchakarma Therapy – Panchakarma therapy to be performed afterpreparatory procedures like Snehana (Oleation) and Swedana(Fomentation). Panchakarma procedures i.e. Vamana (therapeuticemesis) Virechana (therapeutic purgation), Niruha Vasti (decoctionbased enema), Anuvasana vasti (oil based enema) and Nasya (nasaladministration of medicaments) expel out the excessively accumulateddoshas from the body and restores health. Vamana and virechanaprocedures are very effective in chronic respiratory disorders.

2. Medicinal Treatment – Number of herbal and herbomineral preparationsare in practice which strengthen the respiratory system and havecurative effect in respiratory disorders.

Some of the commonly used Ayurvedic – Siddha formulations:

Churna – (i) Sitopaladi Curna, (ii) Talisadi Curna, (iii) Haridra Khanda,(iv) Sringyadi Curna, (v) Sathyadi Curna, (vi) Trikatu Curna, (vii) SomalataCurna

Asava & arishta – (i) Kanakasava, (ii) Vasarista, (iii) Drakshasava,(v) Sirishasava.

29

Vati – (i) Kasturyadi Vati, (ii) Gorochana Vati, (iii) Lavangadi vati, (iv) VyosadiVati.

Avaleha – (i) Kantakari Avaleha, (ii) Thoothuvallai legiyam, (iii) Vyagraharitaki,(iv) Vasa avaleha.

Rasa – (i) Swasa kuthara rasa, (ii) Nagarjunabhra rasa, (iii) Kapha Ketu Rasa,(iv) Swas Kasa Chintamani Ras, (v) Laxamivilas Rasa.

Parpam – Muthuchippi parpam

Kwatha - (i) Sirishadi Kwatha, (ii) Gojihwadi Kwatha.

3. Diet and life style

• Avoidance of exposure to dust, smoke and pollution

• Avoid sleep in day time

• Old wheat, Kulatha (horse gram), Sathi Rice, Parval, Misri, Jaggery, Lasuna,Tulasi, Gomutra, Honey, Raisins, Sunthi, Elaichi, and other hot pungent dietand hot water.

• Yoga

4. Some Rasayana medicines to strengthen Respiratory system and tocombat infections and allergies

• Cyavanaprasha

• Agastya Haritaki Rasayana

• Kantakaryavaleha

• Vasaveleha

• Vardhamana Pippali Rasayana

• Nagabala Rasayan

• Muthuchippi parpam

• Drakshavaleha.

• Brahmi Rasayana

• Madhu (Honey)

30

AYURVEDA AND SIDDHA

Some single Herbs acting on Respiratory System• Yastimadhu (Glycyrrhiza glabra),

• Kantakari (Solanum xanthocarpum)

• Tulsi (Ocimum sanctum)

• Pippali (Piper longum)

• Pushkrarmula (Inula racemosa)

• Vasa (Adhatoda vasica)

• Haridra (Curcuma longa)

• Draksha (Vitis vinifera)

• Banafsha (Viola odorata)

• Shati (Hedychium spicatum)

• Sirisha (Albizia lebbeck)

EVIDENCE BASED RESEARCH1. Kantakari (Solanum xanthocarpum) in Tamaka Swasa (Bronchial

asthma)In a clinical trial on 44 patients of Bronchial asthma, decoction ofKantakari in doses of 60-200ml daily with honey was given for a period of15-20 days on an average. Out of 21 cases of Sleshma pradhana Tamakaswasa, 70-75% shown complete or significant response and out of 23cases of Vata pradhana Tamakswasa 30% showed complete responseand in more than 50% cases significant reduction in intensity of dyspnoeaand cough was observed.

Reference : J.P.Jain, A clinical trial of Kantakari (Solanum xanthocarpum)in cases of Tamaka Swasa, Journal of Reserch in Ayurveda & Siddha,Vol. I No. 3 (1980) PP 447-460.

2. Shirisa (Albezia lebbeck) twak kwatha in Tamaka Swasa (Bronchialasthma)In a clinical trial on 19 patients of Tamaka swasa, Sirisa twak kwatha wasgiven 30 ml thrice daily for 6 weeks. It was found that, a considerablefall of total WBC count (P<0.01), eosinophil count (P<0.01), ESR andincrease the PEFR (P<0.001) were observed which was statisticallysignificant. Effect on subjective and objective parameters was alsohighly significant.

Reference : G.K.Swamy et al., Clinical Evaluation of Sirisa twak kwatha

31

in the management of Tamaka Swasa (Bronchial asthma) Journal ofReserch in Ayurveda & Siddha, Vol. XVIII No. 1-2 (1997) 21-27.

3. Picrorhiza kurroa in Chronic Obstructive Airway Disease

A clinical trial on 45 patients of obstructive airway disease includingbronchial asthma, chronic bronchitis and allergic bronchitis was carriedout with Picrorhiza kurroa 2 caps (500mg each) thrice daily for 4 weeks.A significant reduction in the global score of respiratory signs andsymptoms and eosinophils count was observed. There was significantimprovement in the respiratory function test and with one week oftreatment viscosity of sputum was markedly decreased.

Reference : T.Bikshapathi et al., ‘A clinical evaluation of Picrorhiza kurroa(Katuki) in the management of chronic obstructive airway disease,Journal of Reserch in Ayurveda & Siddha, Vol. XVII No. 3-4 (1996)PP 126-148

4. Vibheetaki (Terminalia chebula) phala Curna in Kasa (Cough) andSwasa

A clinical trial was carried out on 93 patients i.e., 61 cases of Kasa, 12cases of Swasa and 20 cases of Kasa & Swasa mixed type with Vibheetakiphala churna. Vibhitaka was found to possess broncho-dilatory, anti-spasmodic and anti-asthmatic effects.

Reference : V.P.Trivedi et al., ‘A clinical study of the Antitussive andAntiasthmatic effects of Vibhatakiphala Curna in cases of Kasa-Swasa,Journal of Reserch in Ayurveda & Siddha, Vol.III, No. 1-2, PP 1-8.

5. Brihati (Solanum indicum) and Kantakari (Solanum xanthocarpum) inSwasa (Bronchial asthma) and Kasa (Cough)

The decoctions of Brihati and Kantakari were studied to evaluate theefficacy on the patients with Swasa (Bronchial Asthma) and Kasa (Cough).It was found that the effect of Kantakari decoction was better thanBrihati decoction on different clinical parameters like dyspnoea, cough,frequency of asthma attacks per week and severity of asthmatic attack.

Reference : P.P.Gupta et al., ‘A comparative study on Brihati andKantakari in Swasa and Kasa, Vol. XX, No.3-4 (1999) Pg. 191-194.

READING MATERIAL:Monograph on effect of Shirishadi Kwatha and Sweta parpati inBronchial Asthma.CCRAS, New Delhi.

32

AYURVEDA AND SIDDHA

BACKGROUND

The prevalence of various metabolic diseases, such as hypothyroidismand diabetes mellitus is increasing in the elderly population. These diseasesmay be present with non-specific symptoms in the elderly rather than the classicsigns & symptoms of the disease. They may present with fatigue, anorexia,obesity, failure to thrive, loss of motivation and difficulty in concentration.

In India, about 10% elderly people aged 65 or more have Diabetes. Atage the of 40, glucose tolerance begins to decline and at 65-70 years of age23% have impaired glucose tolerance and by the age 80 it may reach to 40%people. The risk of death among people with diabetes is about twice that ofpeople without diabetes of similar age. The Health care cost of Diabetes inthe United States is 132 billion dollars, thus posing a big economic burden inthe country.

Diabetes Mellitus is a group of diseases marked by high level of bloodglucose resulting from defects in insulin production, insulin action or both.Glucose intolerance and insulin resistance increases with age. Diabetes mayleads to serious complications. Diabetes Mellitus poses a wide range ofproblems for elderly people and their families also. These problems includepain, physical disabilities, financial burden, change in life style and threatenedsurvival.

The history of diabetes (Madhumeha) can be traced back in 1000 BC(Caraka Samhita). Descriptions concerning the disease and its managementare available in Ayurvedic literature. Caraka Samhita (1000 BC) and SusrutaSamhita 1000-600 BC) defined madhumeha as the disease in which the patientpasses frequent urine characterized as astringent, sweet. Ayurveda attributesmultifactorial etiology to madhumeha and it has been described as advancedurinary condition which is difficult to cure.


Maharshi Caraka classified subjects of madhumeha into two groupsaccording to their vitality, constitution and disease etiology. Patients are eitherobese and strong or lean and weak. Treatment for obese and strong patientsbegins with Biocleansing procedures (Panchakarma) is aimed at reducing

DIABETES MELLITUS(Madhumeha)

33

the obesity of the patient (Apatarpana Cikitsa) and lean and weak diabeticpatients can undergo milder cleansing procedures followed by the treatmentto build his body with specific management (Santarpana Cikitsa). Both typesof patients are then treated with specific distinct therapy and diet.

Exercise and diet are important adjuncts to the primary diabetes treatment.Vigorous exercise, however, is contra-indicated in lean and weak patients.Instead, diabetic patients are advised to perform specific yoga practicesthat are believed to benefit them at the mind and body level. Yoga is believedto stimulate the endocrine pancreas and improve its function. Stress is also avery important cause of diabetes and yoga, meditation and Ayurvedicmedicines have an important therapeutic value.

Diet is prescribed according to age, body constitution, season, andenvironment as well as the socioeconomic status of the patient. Variouspreparations of Yava (barley) Mudga, (Green gram), Old rice, Karela (Bittergourd), Drumstick, Methi, Snake gourd, Pumpkin, Cucumber, Bimbi (Cocciniagrandis), Watermelon, Buttermilk, Triphala, etc. are beneficial items for diabeticpatients.

AYURVEDIC MEDICINESSingle drugs (Appropriate drug should be selected for two groups.)1. Amalaki (Phyllanthus emblica),

2. Meshasringi (Gymnema sylvestre)

3. Karavellaka (Momordica charantia)

4. Methika (Trigonella foenum-graecum)

5. Shilajit (Black bitumen),

6. Vijaysar (Pterocarpus marsupium)

7. Jambu (Syzygium cumini)

8. Tejpattra (Cinnamomum tamala)

9. Twak (Cinnamomum zeylanica)

10. Guduci (Tinospora cordifolia)

11. Bimbi (Coccinia grandis)

12. Khadirasara (Acacia catechu)

13. Katphala (Myrica nagi)

14. Kakamaci (Solanum nigrum)

15. Devadaru (Cedrus deodara)

34

AYURVEDA AND SIDDHA

AYURVEDIC FORMULATIONS

1. Candraprabha Vati,

2. Silajitwadi Vati

3. Vasanta Kusumakara Rasa

4. Trivanga Bhasma

5. Phalatrikadi Kwatha

6. Vangabhasma,

7. Nisamalaki Curna

8. Kathakakhadiradi Kwatha

9. Mehari Vati

10. Saptacakra Ghana Vati


1. Vijayasara (Pterocarpus marsupium) in NIDDM

A flexible dose open trial was conducted in four centres in India toevaluate the efficacy of Vijayasara in the treatment of newly diagnosedor untreated NIDDM. By the 12 weeks, control of blood glucose hadbeen attained in 69% patients studied. The mean Hb Ac was decreasedsignificantly (P<0.001) to 9.4 % at 12 week from the initial mean of 9.8%.Other laboratory parameters remained stable and no side effects werereported.

Reference: Flexible dose open trial of Vijayasara in cases of newlydiagnosed non-insulin dependent Diabetes mellitus – ICMRcollaborating centres, Central Biostatistical Monitoring Unit, Chennai& Central technical coordinating unit, ICMR, New Delhi.

2. Ayush-82 and Shuddha Shilajit in NIDDM

In a clinical trial on 80 cases of NIDDM, an Ayurvedic formulation namedAyush-82, 5gm thrice daily and Shuddha Shilajit, 500mg twice daily wasgiven for 24 weeks. Fasting and postprandial blood sugar levels wereestimated at 6th weekly intervals. There was statistically significantreduction in both fasting and postprandial blood sugar.

Reference: V.N.Pandey, et.al., An effective Ayurvedic Hypoglycaemicformulation , Journal of Research in Ayurveda and Siddha. Vol. XVI No.1-2, 1995 PP 1-14

35

3. Coccinia indica in Diabetes Mellitus

In a controlled clinical trial on 30 patients of NIDDM, tablets made fromaqueous extract of Coccinia indica twice daily were given before mealfor 3 months. The drug was found to be significantly attenuated the lipidfraction almost to normal range with the control of hyperglycemia.

Reference: S. M. Kamble et al., Efficacy of Coccinia indica W & A inDiabetes mellitus, Journal of Research in Ayurveda and Siddha, Vol.XVII, No. 1-2 (1996) PP. 77-84

4. Ayurvedic Therapy in Diabetic Retinopathy

A combination therapy of tarpana with Patoladi ghrita and internaladministration of Dhanvantara kwatha 20ml, Punarnavasava 25ml,Candraprabhavati 250 mg and Nisamalakai 5 gm twice a day in thesubjects of Diabetic retinopathy showed remarkable improvement invisual acuity. There was no further visual loss, no further focalhaemorrhages and no neovascularisation was observed.

Reference: N.Srikanth, An appraisal of clinical trails in DiabeticRetinopathy, Ayurvedic Management of Diabetes Mellitus, RashtriyaAyurveda Vidyapeeeth, 2005.

5. Ayush-82- An Ayurvedic Hypoglycemic formulation

Ayush-82 consisting of Amra bija (seeds of Mangifera indica),Karavellaka bija (Seeds of Momordica charantia), Jambu beeja (seedsof Syzygium cumini), Gudmara (leaves of Gymnema sylvestre) was triedon a fairly large sample size (350 patients) in a control clinical studyrevealed statistically significant reduction in fasting and postprandialblood sugar in Non Insulin Dependent Diabetes Mellitus.

Reference: CCRAS Research – An Overview, Central Council forResearch in Ayurveda and Siddha. Janakpuri, New Delhi- 2002.

READING MATERIAL:

CCRAS Research – An Overview, Central Council for Research inAyurveda and Siddha. Janakpuri, New Delhi- 2002.

36

AYURVEDA AND SIDDHA

BACKGROUND

Older adults frequently present with gastrointestinal disorders due tosignificant changes in the gastrointestinal functions with aging. These includea variable diminution in the secretion of hydrochloric acid and digestiveenzymes of stomach, intestine, liver and pancreas. Poor olfactory sensation,impaired taste detection and discrimination and increase of satiety hormone(Cholecystokinin) leads to poor appetitie in old age. Relaxation of loweresophageal sphincter, decreased mucosal prostaglandin synthesis in thestomach and atrophy of small intestine with decrease in number of folliclesand payer’s patches occurs with aging process, which are responsible fordigestive disorders.

Many of the digestive complaints of the elderly may be due to alteredmotility and secretion and are usually considered functional in origin. They areoften difficult to measure and to identify clearly. Most patients with cirrhosisof liver present between 40 and 70 years of age. Symptoms of digestivedisorders become a matter of increasing concern to an older patient. Poorappetite, heartburn, dyspepsia, flatulence, diarrhoea or constipation may alsobe associated with emotional factors in the elderly patients.

Flatulence and intestinal gas occurs in almost every elderly individual. Itis often associated with constipation. Approximately 30% healthy elderlypeople use laxatives regularly. If this problem is not addressed properly maylead to anal fissures, hemorrhoids and fistula-in-ano.

The diseases of the digestive system result in poor nutrition and weightloss. The multiplicity of the diseases in aging population often need multi drugmedication which may lead to poor appetite, loss of appetite, heartburn andmany other related problems.

Ayurveda believes that digestive disorders occur due to altered lifestyle&faulty food habbits. Inappropriate food includes insufficient food, and evenstarvation, excessive amounts of both food and water, wrong foodcombination which results in poor appetite, indigestion, diarrhoea and otherdigestive disorders. Overeating of high fat foods, which can result in obesity.Ama-producing food (certain food combinations lead to toxemia) causes

DIGESTIVE DISORDERS(Pacanasamsthanagata Roga)

37

digestive disorders. The factors such as time of eating, manner of eating, eatingwhen mind is burdened with worries etc., also precipitate digestive disorders.

Food not compatible to body, mind, constitution (Prakriti) may causedigestive disordersimmunity and cause diseases. According to Ayurveda,every food has its own taste (rasa), a heating or cooling energy (virya) andpost-digestive effect (vipaka). When two or three different food substancesof different taste, energy and post-digestive effect are combined together,agni can become disturbed and inhibiting the enzyme system and resulting inproduction of toxins in the system. Combining food improperly can result indigestive disorders like indigestion, diarrhoea, and gas formation.

Lack of proper and systematic lifestyle also leads to the chain of reactionsto cause digestive disorders.

Ayurveda manages these digestive disorders by managing Jatharagni(Digestive fire and liver function) and balancing the doshas with the help offood, lifestyle and medicines. Ayurveda offers a rational and scientificapproach for determining correct diet, which is, based upon an individual’sconstitution i.e. Vata, Pitta and Kapha. This constitution is the basis ofdetermining which foods are best for maintaining physiological balance for agiven individual.

Panchakarma treatment along with various Ayurvedic preparations iseffective in treating the gastro intestinal disorders.

POTENTIAL AND STRENGTH OF AYURVEDA

Diet and lifestyle changes – Food and diet are important component ofmanagement of digestive disorders. Ayurveda relies primarily on theadoption of lifestyle and food habits maintain the Jatharagni that reducesthe fat, accumulation of dosha in the body and keep the dosas in normalstate. Adoption of food habits mentioned in Ayurveda as one should noteat too fast, too slow, not talking or laughing while eating. One should eatwarm, unctuous food, in proper quantity and only after the digestion of previousmeal etc can prevent the occurrence of such disorders. Irregular, untimelyand excessive eating are important causes to disturb the digestion, whichlead to the gastro intestinal disorders.

Panchakarma- Panchakarma is Ayurveda’s primary purification anddetoxification treatment. Panchakarma means the “five therapies”. These5 therapeutic means of eliminating toxins from the body are Vamana,

38

AYURVEDA AND SIDDHA

Virechana, Niruha and Anuvasana Vasti and Nasya. This series of five therapieshelp to remove vitiated dosas and illness causing toxins from the body andbalancing the dosas. In elderly people selective one or two proceduresmay be required to manage the digestive disorders.

Medicinal treatment: Ayurveda has a wide range of medicines for digestivedisorders described under Deepaniya, Pacaniya, Stambhana, Grahi,Anulomana, Rechana, and Bhedana class of drugs.

For Poor appetite and Dyspepsia:

1. Lavana bhaskara Curna

2. Hingvastaka Curna

3. Saindhavadi Curna

4. Sunthyadi Curna

5. Vaiswanara Curna

6. Narayana Curna

7. Shivakshara pachan Curna

8. Hingvadi Vati

9. Citrakadi Vati

10. Ajirnakantaka Rasa

11. Agni kumara Rasa

12. Vishatinduka Vati

13. Drakshasava

14. Kuberaksha Vati

15. Kankayana Vati

For Diarrhoea:

1. Siddha praneshwara Rasa

2. Dadimastaka Curna

3. Bilwadi Curna

4. Gangadhara Curna

39

5. Kapithashtaka Curna

6. Lasunadi Vati

7. Sankha Vati

8. Sanjeevani Vati

9. Anandabhairavi Ras

10. Kutaja Ghana Vati

11. Siddha Praneswara Ras

12. Karpura Ras

13. Pathyadi Curna

14. Jatiphaladi Curna

15. Cangeryadi Gutika

For vomiting:

1. Bilwadi Avaleha

2. Eladi Vati,

3. Dadimashtaka Curna

4. Chardiripu Vati

5. Dadimavaleha

6. Mayurapinccha Bhasma

For IBS:

1. Citrakadi Vati

2. Hingwastaka Curna

3. Sankha Vati

4. Maha gandaka Rasa

5. Agnitundi Vati

6. Panchamrita Parpati

7. Kravyadi Rasa

8. Kaidaryadi Kvatha Curna

40

AYURVEDA AND SIDDHA

9. Pippalyasava

10. Takrarista

11. Shatapushpadi Curna

12. Jeerakadyarishta

For Hyperacidity:

1. Avipattikara Curna

2. Amalaki Curna

3. Yastimadhu Curna

4. Sutasekhara Rasa

5. Kamadudha Rasa

6. Pravala Panchamrita

7. Pravala Pisti

8. Dhatri Lauha

9. Indukantha Ghrita

10. Misreya Curna

For Constipation:

1. Triphala Curna

2. Panchasakara Curna

3. Shatsakara Curna

4. Eranda Taila

5. Dantiharitaki

6. Hingu triguna Erandam

7. Isabgol Husk

8. Draksharishta

9. Abhayarishta

10. Kumaryasava

41

For liver disorders:

1. Arogyavardhini Vati

2. Phalatrikadi Kwatha

3. Katuki Curna

4. Bhunimbhadi Kwatha

5. Rohitakarista

6. Avipattikara Curna

7. Bhumyamalaki Swarasa

8. Eranda Pallava Swarasa

9. Vasaguducyadi Kvatha

10. Kumaryasava

11. Rohitakarishta


1. Ayurvedic combination in Kamala (Jaundice)

A combination of Punarnava mandura 500 mg along with ArogyavardhiniVati 1 gm thrice daily for 21 days was tried in a clinical trial on 37 patientsof Kamala (Jaundice). The combination showed antiviral, anti-inflammatory and purgative effect in Kamala.

Reference: S.K.Singh et al., Study of herbomineral therapy - effect inthe case of kamala (Jaundice), Journal of Reserch in Ayurveda & Siddha,Vol. XXVI No. 1-2 (2005) PP 45-51

2. Ayurvedic combination in Parinama Soola

In a placebo controlled clinical trial, a combination of Narikela Lavanain a dose of 1g of twice daily and Tiktaka ghrita 10 gm once daily in earlymorning with hot water in the treatment group and starch tablets asplacebo was given for 4 weeks. It was found that, in the trial drug group80% patients were cured and 20% were improved while with placebono significant response was noted.

Reference: Sulochana Muddepal et al., Clinical study on the efficacyof Narikala Lavana and Tiktaka Grita in Parinama Soola, Journal ofReserch in Ayurveda & Siddha, Vol XXVII, No. 3-4 (2006) PP 1-9

42

AYURVEDA AND SIDDHA

3. Panchamrita Parpati in Grahani Roga (Ulcerative colitis)

In a control clinical trail, the administration of a combination of allopathicmedicine (Sulphasalazine and Prednisolone) and Panchmrita parpatikalpa in the management of 30 cases of Grahani roga (Ulcerative Colitis)produced highly significant improvement in various symptoms of thepatients, without producing any side effects in comparison to the othertwo groups i.e. allopathic medicine or Panchamritaparpati alone.

Reference: Ajay Kumar Sharma et al., Evaluation of the efficacy55 ofPanchamrita parpati in the management of Grahani roga vis-à-visUlcerative colitis. Journal of Reserch in Ayurveda & Siddha, Vol. XXVII,No. 1-2 (2006), PP- 24-40

4. Bhumyamalki (Phyllanthus amarus)- a promising Hepatoprotectiveagent

A clinical trail of Bhumyamalki (Phyllanthus amarus) in chronic viralhepatitis for a period of three months revealed remarkable recovery ofliver function and inhibition of HBV replication.

Xin Hua, W. et al., A comparative study of Phyllanthus amarus compoundand interferon in the treatment of chronic Viral Hepatitis B, B.J. Trop.Med. Public health, 31, 140, 2001.

5. Comparision of different drug schedules in Grahani Roga

In a clinical trail, a comparative study was done with a herbomineralcombination of Kutaja Ghana vati 1gm thrice daily with 2 drops of Sankhadrava in one group and Herbal combination of bark of Kutaja(Holarrhena antidysenterica), beans of Babula(Acacia arabica), fruitpulp of Bilva (Aegle marmelos) and seeds of Sveta Jirka (Cuminumcyminum) 1gm thrice daily in another group. It was found that all thepatients respond to both the therapies and the second therapy was moreeffective than first therapy.

Reference: Naresh kumar et al., A comparision of Different drugSchedules under different groups of Grahani Roga, Journal of Reserchin Ayurveda & Siddha, Vol. XVIII, No. 3-4 (1997), pp 79-88.

READING MATERIAL:

Monograph on Parinama sula ( Peptic Ulcer), CCRAS, New Delhi.

43

BACKGROUND

Psychosomatic disorders are increasing in number and leading to thelarge number of health problems and complications. Incidence ofPsychosomatic disorders is increasing because of many factors but the mostimportant factor is urbanization and fast so called modern lifestyle of today.Prevalence of all the psychiatric disorders observed to be 65.4 per 1000population. Prevalence of Schizophrenia is 2.3/1000; depression is 31.2/1000and anxiety neurosis is 18.5/1000. There are several neuropsychiatric medicalconditions that are frequently seen in elderly like Dementia, Alzheimer’s disease,Parkinson’s disease and psychosomatic disorders like depression, anxiety,hypertension, insomnia, etc..

Advanced age among the elderly has been hypothesized to be a riskfactor for depression. Depression contributes to significant psychological andphysical distress, physical disability and higher mortality. Acetyl choline,dopamine and norepinephrine decrease in the CNS in the advancing age,elevated levels of MAO & decrease in no. of neuro-receptors contribute tothe vulnerability to depression in older adults. Depression presents most oftenas anxiety in older peoples. The presence of co-morbid anxiety disorder isassociated with poor social functioning and a higher level of somatic symptomsand even suicidal tendency.

All statistics show a sharp rise in the prevalence of dementia with age.Between 1990 and 2010 the number of dementia cases in the developedcountries will project to increase from 7.4 million to 10.2 million. This predicteddata shows that it affects the individual as well as the economy of the country.

Parkinson’s disease is a hereditary degenerative disorder. It is one ofmost common crippling diseases. It strikes 2/1000 people in USA. Because ofincreased longevity, roughly 60,000 new cases are diagnosed annually.Parkinson’s disease is the most common extrapyramidal disease affecting theelderly. Tremor is the common presenting symptom.

Conventional medical therapy to treat psychosomatic diseases includesuse of antidepressants, psychostimulants and electroconvulsive therapy.

PSYCHO NEUROLOGICAL DISORDERS(Mano evam Nadi tantrika roga)

44

AYURVEDA AND SIDDHA

Neuropsychiatric complications like delirium, dry mouth, blurred vision, urinaryretention and insomnia are the common side effects leading to noncompliance. Thus there is no effective therapy without side effects inconventional system of medicine for psychosomatic disorders.

Ayurvedic classics describe psychosomatic illness under differentheadings. Much description is available in the disease ‘Unmada’. Descriptionof other conditions like chittodwega (Anxiety), Avsada/Vishada (Depression),Anidra (Insomnia), Smritinasa (Loss of memory) and Kampavata (Tremors) areavailable in Ayurvedic texts.


Ayurveda has various therapeutic modalities to improve thepsychological, neurological, intellectual, physical and social functioning ofelder people to make them adjustable in the society in a better way, therebyimproving the quality of life and making him socially useful.

Concept of Satvavajaya Cikitsa (Psychological therapy) is uniquelymentioned in Ayurveda. By following Sadvritta (Good social conducts), onecan prevent the occurrence of Psychiatric illness. Panchakarma therapy toclean the channels of body, mind and various Medhya Rasayana formulationswhich act on manovaha srotas are the hallmark of Ayurvedic treatment.Number of Ayurvedic formulations are used in Ayurveda for the managementof these disorders.

Concept of Satvavajaya Cikitsa (Psychological therapy)- This therapy aimsat restrainment of mind from the unwholesome objects. Treatment with aadvice from the knowledgeable people to prevent negative thinking,promotes positive approach. Various Mani, Mantra, Oushadhi andPanchakarma procedures with medicines are advocated in Ayurveda.

Panchakarma Therapy – Vamana, Virechana and Vasti etc., should beadvocated according to the preponderence of dosha involved. This therapycleanses the channels of body and mind so that nutrition can be provided tothe body. The patient attains mental peace, good memory and mental health

• Nasyakarma (Nasal administration of medicaments) is the root of choicein the diseases of head and supraclavicular region. Sodhana Nasya canbe given for cleansing the channels of head & Brimhana Nasya providesnutrition to check the process of degeneration.

• The external therapeutic applications like sirovasti, Takradhara, Siro pichuetc, are also useful in tranquilizing the agitated mind.

45

Medhya Rasayanas in Psychiatric disorders - Rasayana drugs have quality ofenhancing memory, intelligence and strength of body, mind and sense organs.

Medhya rasayanas viz., Juice of Mandukaparni, Guduchi, powder ofYastimadhu and paste of Sankhapushpi are intellect promoters.

• Brahmi rasayana

• Aswagandha Ghrita

Single Drugs for Psychoneurological disorders

1. Brahmi – Bacopa monnieri

2. Sankhpushpi - Convolvulus pleuricaulis

3. Mandukparni - Centella asiatica

4. Aswagandha -Withania somnifera

5. Kapikacchu - Mucuna pruriens

6. Vaca - Acorus calamus

7. Jatamansi - Nordostachys jatamansi

8. Guduci - Tinospora cordifolia

9. Bala - Sida cordifolia

10. Badam - Prunus amygdalus

11. Goghrita - Cow ghee

12. Godugdha - Cow milk

Ayurvedic Formulations

Curna -

1. Saraswata Curna,

2. Aswagandha Curna

Vati -

1. Brahmi Vati,

2. Sarpagandhadi Vati

3. Manasamitra Vati

46

AYURVEDA AND SIDDHA

Asava -

1. Aswagandharista,

2. Saraswatarista

Taila -

1. Jyotishmati Taila,

2. Brahmi Taila

3. Himasagara Taila

4. Tungadrumadi Taila

Ghrita -

1. Maha Pancagavya Ghrita

2. Kalyanaka Ghrita

3. Saraswata Ghrita

4. Bramhi Ghrita

Rasoushadhis -

1. Manasamitra Vataka

2. Smriti Sagara Ras

3. Yogendra Ras

4. Caturbhuj Ras

5. Pracand Bhairav Ras

6. Brihatvata Cintamani Ras


1. Brahma Rasayana an Antianxiety formulation.

In a double blind cross over trail, 15 cases of anxiety neurosis wererandomly divided into 3 groups receiving placebo or diazepam or brahmaRasayana. The overall result showed that. Brahma Rasayana is moreeffective in enhancing perceptual discrimination and psychomotorperformance than the other two groups.

Reference: Ajay K. Sharma. Antianxiety effect of classical Ayurvediccompound, Brahma Rasayana, Journal of Reserch in Ayurveda & Siddha,Vol.XXIII, No.3-4 (2002), pp. 33-48.

47

2. Ashwagandha and Kapikacchu in psychiatric disorders

Aswagandha and Kapikacchu were studied for anxiety and depressivedisorders respectively in 60 Psychogeriatric patients for 3 months.Aswagandha and Kapikacchu were found to promote positive healthto retard biological and psychological aging factors and to control thepsychological symptoms.

Reference: K.K.Dwivedi et al., A study of Psychiatric symptoms ofgeriatric patients and the response to Ayurvedic therapy, Journal ofReserch in Ayurveda & Siddha, Vol.XXII No.3-4 (2001), Pg 198-207.

3. An Ayurvedic formulationin the management of depressive disorders

An Ayurvedic compound containing organic extract of Guduchi(Tinospora cordifolia), Mandukparni (Centella asiatica) and Basant(Hypericum perforatum) in a dose of 1200 mg/50 kg body wt were studiedin a control clinical trial, which revealed considerable reduction in thedepression score and mental fatigue level in depressive patients.

Reference: Gayatri Juneja et al. Depressive disorders among elderly-its prevention and management by an Ayurvedic formulation. Ayurvedicconference on Rasayana, Rashtriya Ayurveda Vidyapeeth, 2002.

4. Brahmi (Bacopa monnieri) in the management of Senile Dementia.

Brahmi vs Placebo: Administration of 1 gm. of powdered extract ofBrahmi twice a day for 5 years has shown significant reduction in theprogression of memory loss in persons suffering from senile dementia.

Reference: Role of the Ayurvedic drug Brahmi (Bacopa monnieri) inthe management of Senile Dementia. Pharmacopsychoecologia(1990),3,47-52.

5. Ashwagandha – a potent anti-stressor agent.

Anti-stress property of Withania somnifera has been experimentallystudied in adult Wistar strain albino rats. In this study, the drug treatedanimals showed better stress tolerance.

Reference : R. Archana et al., Antistressor effect of Withania somnifera,Journal of Ethnopharmacology, 64 (1999), 91-93.

48

AYURVEDA AND SIDDHA

BACKGROUND

There are vast number of surgical problems that occur in elderlypopulation eg. Gall Bladder stones, BPH, renal/vesical calculus, Coronaryartery disease, Hernia, Piles, Fistula-in-ano etc., and Prolapse of rectum.

As the population grows, older patients will present for the treatment ofsurgical disease. When treating older patients main focus shift from maximizinglongevity to maximizing the quality of life, maintaining dignity and minimizingsufferings.

Age related changes as decrease the vital capacity, cardiaccomplications associated with general anesthesia and a gradual loss ofreserve capacity decreases the patient’s ability to tolerate surgery. Thesurgeon identifies those at risk for complications and considers alternativemodalities of surgical treatment.

Out of above mentioned surgical problems in the elderly Ayurveda offersalternative management for BPH, renal disorders (eg. calculus, chronic renalfailure etc.), piles, fistula-in-ano and anal prolpase.

Benign Prostatic Hyperplasia (BPH) is a progressively worsening conditionassociated with aging. Onset of this disease is seen after forties due to theenlargement of prostatic gland. Due to its location, the enlarged prostatebulk may subsequently increases the resistance of the proximal urethra to theoutflow of urine. This results in higher pressures generated by the bladder toovercome the obstruction. Progressively, the bladder musculaturedecompensate, resulting in a weak and flabby bladder with diverticuli. Stasisof urine harbors infection and bladder stone formation. This high bladderpressures may be transmitted to kidneys resulting in Hydronephrosis andHydroureters and gradual loss of renal function.

Maharshi Susruta (1000 BC), a great surgeon advised surgical treatmentfor many diseases and the procedure advocated by him is being practicedeven today. But Surgery in geriatric patients should be avoided if possible.Ayurveda has many treatment options, which can manage/can reduce thesufferings due to such disorders. Ayurveda provide minimum invasive

SURGICAL PROBLEMS IN ELDERLY

49

parasurgical techniques like Kshara sutra therapy for the management of somesurgical disorders like Piles, fistula–in-ano etc.,


Ksharasutra Therapy- Ksharasutra is a unique minimal invasive parasurgicalmeasure successfully practiced as promising therapy for the management ofano rectal disorders. The prolonged internal pile masses and external pilescan be treated successfully by ligation of the Ksharasutra around pile masses.The Ksharasutra is tied in the fistulous tract and is changed every week till thewhole tract is excised and healed symultaneously. It is a very successivemethod of the treatment. The recurrence rate after Ksharasutra therapy isvery low (3-5%) and the patient need not to be hospitalized. Need ofAnaesthesia and antibiotics are negligible.

1. Piles (Haemorroids)

1. Arsakuthar Rasa

2. Arsoghna Vati

3. Kankayana Vati

4. Pranada Vati

5. Sigru Guggulu

6. Rasanjana Vati

7. Abhayarista

8. Prabhakar taila (for external use)

9. Surana Avaleha

10. Dantiharitaki

Beningn Prostatic Hypertrophy (BPH)

1. Varunadi Guggulu

2. Shigru Gugulu

3. Kanchanara Guggulu

4. Chandraprabha Vati

5. Shilajitvadi Vati

50

AYURVEDA AND SIDDHA

6. Punarnavasava

7. Gokshuradi Guggulu

8. Brihatyadi Kwatha

9. Varun Sigru Kwatha

10. Dasamoola Kwatha

11. Narayana Taila (for Vasti)

Calculus:

1. Pashanabhedadi Curna

2. Gokshuradi Guggulu

3. Varuna Sigru Kwatha

4. Sweta Parpati

5. Kulutha Kwath

Anti-inflammatory Drugs

1. Guggulu

2. Varuna

3. Sigru

4. Gokshura

5. Punarnava

6. Silajitu


1. Kravyadi Rasa, Kaseesadi Taila Vasti and Triphala Churna in Hemorrhoids

In a single blind clinical trail Kravyadi Rasa – 500mg thrice daily, KaseesadiTaila 10 ml per rectal and Triphala Churna 5 gm at bed time on 50 patientsof bleeding piles showed complete relief in 28 cases and marked reliefin 13 cases.

Reference: A clinical study on the effect of Kravyadi Rasa, KaseesadiTaila Vasti and Triphala Churna in the management of Arsas

51

(Haemorrhoids), Journal of Reserch in Ayurveda & Siddha, Vol. XXV,No.1-2 (2004), PP 1-10.

2. A Compound Ayurvedic Formulation – For Haemorrhoids

A single blind clinical trial was conducted on 182 patients of Arsa(Haemorrhoids) to evaluate the efficacy of Kaseesadi taila vasti – 10 ml,Kankayanavati – 500mg thrice daily, Kravyadi rasa – 500mg thrice daily,Abhayarista 25 ml thrice daily and Triphala curna – 5gm at bed time. Itwas found that 31.31% cases got complete relief and 29.12% got markedrelief.

Reference: Therapeutic Evaluation of compound Ayurvedic formulationin the management of Arsas (Hemorrhoids) – A Clinical Study, Journalof Reserch in Ayurveda & Siddha, Vol. XXII, No.3-4 (2006), PP-81-91

3. Ksharasutra in the management of Fistula-in-Ano

In multicentric randomized controlled trial, the efficacy of Ksharasutra inthe management of Fistula-in-ano is compared with conventionalsurgery, which concluded that long term outcome with Ksharasutra isbetter than surgery although initial healing time is longer. Ksharasutrathus offers an effective, ambulatory and safe alternative treatment forpatients with Fistula-in-ano.

Reference: ICMR collaborating centres and other units. Multicentricrandomized controlled clinical trial of Ksharasutra (Ayurvedicmedicated thread) in the management of Fistula-in-ano, Indian J. Med.Res. (V) 94, June 1991, PP 177-185.

4. Teekshna Ksharasutra in Fistula-in-ano

A clinical study has been conducted on 100 patients of Fistula-in-ano,divided into 2 groups; in control group standard Ksharasutra (Apamargakshara + Snuhi ksheera and Haridra) was applied and in treatment groupthe Teekshna ksharasutra containing Apamarga, Palasa, Kutaja etc. wasapplied. The average unit cutting time in control group was found to be6.6 days/cm, while in treated group the average U.C.T was just 5 days/cms.

Reference: Role of Teekshna kshara Bhavitasutra in the managementof Bhagandara (Fistula-in-ano), Journal of Reserch in Ayurveda & Siddha,Vol. XX, No.3-4, (1999), PP-130-140.

52

AYURVEDA AND SIDDHA

6. Sweta Parpati with Pashanabheda and Goksura in Mutrasmari

Effect of Ayruvedic drugs Sveta Parpati with Pashanabheda and Goksuruin the management of Mutrasmari (Urolithiasis) was evaluated in 30radiologically established cases of renal and ureteric calculi wereincluded. One gm. of Sveta parpati with 50 ml. of Pasanabheda goksurukwatha was given thrice daily. The assessment of the response of thetherapy was made on the basis of relief in presenting symptoms and theradiological findings. The results have shown that Urolithiasis could bewell managed with Ayurvedic therapy. The radiological findings alsosupport the elimination of stone and reduction of their size.

Reference: CCRAS Research an overview ,CCRAS 2002 , pp55

7. Palasa ksara in the management of Mutrasmari (Urolithiasis)

The effect of Palalsa ksara in the management of Mutrasmari (Urolithiasis)was evaluated on 50 radiologically established cases. Out of 50 cases,24 were having Renal calculus (Vrikkasmari) and 26 were having Uretericcalculus (Gavini asmari). Palasa ksara was given in the dose of 1 gm.thrice daily with water. The clinical and radiological findings reveal theelimination of stone and reduction of their size.

Reference: CCRAS Research an overview, CCRAS 2002, pp55

READING MATERIAL:

1. Monograph on clinical studies on Bhagandara (Fisstulo-in-ano) CCRAS,New Delhi.

2. Monograph on "Clinical studies on Arsha (Hemorrhoids)" CCRAS, NewDelhi.

3. Book "Kshara sutra therapy for Ano rectal disorders", Dr. S.K. Sharma,RAV Publication, New Delhi.

4. Monograph on "effect of Varuna, Kuluthha& Gokshura in themanagement of Urinary calculus", CCRAS, New Delhi.

5. Monograph on "Management of BPH", CCRAS, New Delhi.

53

1. Institute of Post Graduate Teaching & Research in Ayurveda,Gujarat Ayurved UniversityAdministrative Bhavan,JAMNAGAR- 361 008.(Gujarat) India.Phone (O) : 0288-2676854, Fax : 0288-2555585Email :[email protected]://www.ayurveduniversity.com

2. National Institute of Ayurveda,Madhav Vilas Palace, Amer Road, Jaipur-302002,Phone No:- 091-141-2635709,2635816, Fax: 91-141-2635709, Website: http://nia.nic.in,Email: [email protected]

3. Institute of Medical Sciences,Banaras Hindu UniversityVaranasi, India -221005Phone 0542 - 2307500, 2367568,Fax 91-542-2367568http://www.bhu.ac.in/ims/index.html

4. R. A. Podar Medical College (Ay)Dr. Annie Besant Road, Worli,Mumbai – 400 018Telephone: 022 – 4936881/ 4934214Hospital: 022 – 4931846/ 4933533Website: www.ayurvedinstitute.com

5. Govt. Ayurveda College HospitalTrivandrum, KeralaHospital Ph: 0471 - 2460823College Ph: 0471 – 2474190

SOME CENTERS OF EXCELLENCE(Ayurveda & Siddha) FOR GERIATRIC CARE

APPENDIX - 1

54

AYURVEDA AND SIDDHA

6. Arya Vaidya Sala,Kottakkal-676503, Malappuram Distt, KeralaTel: 0483/2742216-19, 2742561-64, 2742571, 2744506-08Fax: 0483-2742572E-mail: [email protected]: www.aryavaidyasala.com

7. Central Research Institute (Ayurveda)Cheruthuruthy, Via ShoranurTrichur Distt.Kerala-679531Fax: 04884-262366, Phone: 04884-262543M: 09446501746E-mail: [email protected]

8. National Institute of SiddhaThambaram SanatoriumChennai-47 Reference:044-22411611(Telefax)098447211057email. [email protected]@gmail.com

9. Central Research Institute (Siddha),A.A. Govt. Hospital Campus,Arumbakkam, Chennai-600106Phone No: 044/26214809(O)

10. Regional Research Institute (Siddha)Chellaperumal Street, KuyavarpalayamPondicherry-6050060413/2245072 (Telefax)E-mail: [email protected]

11. Govt Siddha Medical College & Hospital,PalayamkottaiTirunelvelli-2

12. Govt Siddha Medical College & Hospital,Aringar Anna Hospital, Campus, Arumbakkam, Chennai-106Phone: (044) 26281563, 26214844

55

Agewell India,M-8A, Lajpat Nagar, Part-2, New Delhi

Help Age IndiaC-14, Qutub Institutional Area, New Delhi 110 016

Rajasthan Voluntary Health Association,A-12 (B), Maheveer Udyan Path, Bajaj Nagar, Jaipur-302 015

Voluntary Health ServicesTechnical Teachers Training Institute- Post, Chennai-113, Tamilnadu

Healthy Services Society,406 & 501, 14th Street, Himayat NaagarHyderabad-29

Missionary of Charity,(Mother Teressa Centre),54A/AJC Bose Road, Kolkata-700016

Ramakrishna Math & Mission P.O. Box Belur Math, District- Howrah, West Bengal-711 202 Phone: 011-91-33-6541144, 011-91-33-6541180,Fax: 011-91-33-6544346Email: [email protected]

Help Age India ,No.34-A/44,Guruchhalya Manish Nagar,P.O. Azad Nagar, Andheri (West), Mumbai 400 053

West Bengal Voluntary Health Association19 A, Dr. Sundari Mohan Avenue,Kolkata Dist. Kolkata 700 014

SambandhPlot No.2926/5198, Jaydev NagarLewis Road, Bhubaneshwar- 751002

SOME NGOs ENGAGED IN GERIATRIC CARE ANDOTHER HEALTH PROGRAMMES

APPENDIX - 2

Documents

Ayurveda and Geriatric Care